These women may be Syrian refugees or arrivals from Africa, or France, or Spain. They speak countless languages and may not be familiar with the medical protocols and cultural norms of their new home.

And this reality is not without its challenges. Sweden has good rates of maternal complications and mortality, but immigrants face outcomes six times worse than their native-born counterparts.

That said, a simple new initiative has been changing that for immigrant women giving birth -- and the practice is rooted very much in medical collaboration and care coordination.

A recent article in the New York times explores Sweden's immigrant maternal health challenge -- in which foreign-born women face outcomes six times worse than Sweden-born women. Of course, these women may have significant linguistic and cultural barriers, keeping them from accessing the same standard of care.

This collaboration intervention comes in the form of "doula culture interpreters" -- trained women who assist a pregnant woman in her labor, supporting her in communicating with her midwife or doctor as well as helping her understand the norms and practices in the birthing process. These doulas translate from the immigrant’s home language and culture into their adopted language and culture. But they also translate the medical system, culture, and jargon.

Sometimes the participation of the doula is as simple as literally translating from Swedish to, say, Arabic. Other times, the "translation" is from medical-speak to plain language. “Good communication is listed as one of the best ways to improve outcomes,” Dr. Esscher, a Swedish obstetrician, said in an interview. And, indeed, the doulas' support of good communication, has been having an effect on outcomes.

I found this doula project inspiring in its simplicity. It's an intervention that doesn't involve displacing or dramatically changing any current practices or providers. It simply improves communication, collaboration, and coordination with the assistance of one of the doula interpreters. I also think that this kind of approach spotlights the importance of having collaboration tools that are flexible enough to involve multiple kinds of collaborators.

For instance, the old telemedicine paradigm of a one-to-one videoconference or text message thread between two doctors simply isn't enough to support this kind of approach. Rather, a truly team-based approach in which, perhaps, the doula interpreter, the obstetrician, and the midwife could all collaborate on postpartum or antenatal care, that is the approach that is truly necessary. Knowing this need generally, iClickCare has been structured to enable medical collaboration among multiple members of the care team, regardless of medical training, across the continuum of care. In an age when our care team includes a range of providers, offering a range of perspectives, this kind of tool is not only helpful, it's indispensable.

To me, this program brings up questions that apply to all of us in medicine. First: We’re in a time where immigration and refugees are one of the challenges and opportunities that many countries face. How might we ensure that all people in our country experience the same quality of care and outcomes? And perhaps even more crucially: we're in a time when medical care is increasingly team-based, with a diversity of training levels and perspectives. How might we make sure that all members are engaged to provide the most coordinated, nuanced care possible?

For many rural clinics and hospitals, that has meant closing or consolidating. And for people in rural areas, that has meant limited access to care or extremely long drives to receive care. For instance, this article tells the story of a new mom in Missouri who was making regular 200-mile trips to be with her newborn twins in the NICU. Then she’d drive back home to be with her 2-year-old and go to work.

Rural medicine, whether in remote areas or in places like Native American reservations, has always come with its unique joys, gifts, and challenges. But the more medicine evolves, the greater the pressure on these rural providers and hospitals seems to be.

The New York Times reports, “At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010.”

One doctor commenting on the article describes the situation from his viewpoint: “The main issue I’ve seen working in health care is consolidation of smaller systems into larger collectives. Smaller rural hospitals are bought by the larger systems, which in turn buy out practices, and end up owning everything in a three to five county radius — sometimes more. The system shunts patients to their main facilities and either closes or cuts back on services offered at the smaller hospitals. It’s not surprising, because it is a balancing of limited resources in a for-profit system, but it does leave the most vulnerable without access to care.”

Certainly, these pressures are a reality. And many providers and patients are dealing with that reality on a daily basis. But these articles also led us to wonder whether there are other solutions to these challenges, beyond the 200-mile drive to care for a newborn.

We’ve worked with many providers, clinics, and hospitals in remote areas who find that by using telemedicine, they’re able to dramatically expand their offerings and capabilities, while decreasing costs.

For instance, with hybrid store-and-forward telemedicine, even a more bare-bones staff is able to get consults on cases that they’d normally have to send to a much larger care center, many hours away. Furthermore, the staff is able to coordinate care for patients so that they may be able to avoid unnecessary visits to distant centers.

So although telemedicine can't fix everything—a woman in labor still usually needs a maternity ward that's closer than 100 miles from her home—there are creative ways of working within these new constraints. And telemedicine, care coordination, and medical collaboration are three tools that may help.

To learn more about hybrid store-and-forward telemedicine and how it can help in rural settings, download our free guide:

Medicine is an altruistic career path for most of the people who undertake it.

Certainly, there are those who pursue it for the perceived salary benefits, but most health care providers pursue medicine as a means to help people, and to achieve a level of professional excellence.

Sometimes I wonder if this is why many doctors are very resistant to “anything extra.” We feel so overtaxed by the altruistic work we do every day that we simply can’t comprehend adding anything else to an already full plate — both practically and emotionally.

Although there are altruistic reasons to do healthcare collaboration and use telemedicine, I also believe that there are selfish reasons as well. And perhaps the best professional practices are those that sit at the intersection of both.

Yes, telemedicine is altruistic in the sense that it improves outcomes for our patients.

But the reality is that, as medical providers, we benefit as much as the people we are treating, do. So I thought back to the benefits that my colleagues who use iClickCare have experienced and realized that the benefits to the individual provider are meaningful and concrete.

5 Concrete Ways that Telemedicine-Supported Healthcare Collaboration is Good for Medical Providers:

It gets you home to your kids faster. The reality is that working with colleagues on a diagnosis but not having to play phone tag to do so will save time -- those minutes grabbed during "lunch" (obviously just a sandwich while you do notes) or at the end of the day. And that means that you are delivering the care you know is appropriate, but you're home for dinner faster.

It can improve data and sophistication of care. I was really interested to see this article describing the healthcare collaboration among several competing health systems to share data to support precision medicine. Many of our newest technologies, including precision medicine, require resources and knowledge that we just don't have on our own. Just as sharing the burden of a specialized diagnosis can increase what we know, sharing data can increase our capabilities.

It will decrease burnout. Healthcare provider burnout is exacerbated by providers' feeling of inefficacy in their work, overload in work quantity, and a feeling of disconnection from their patients. Healthcare collaboration can support improvements around all three things. Especially when supported by a telemedicine tool, healthcare collaboration can increase your feelings of connection and efficacy but not increase your workload or time burden.

It makes your day more manageable. Playing phone tag might be done in stolen minutes throughout the day, but those minutes add up. Videoconferencing can further grab hours and attention. But healthcare collaboration that's asynchronous doesn't need to be a burden at all. It can actually streamline diagnoses, care plans, and your appointment schedule.

It can keep you HIPAA safe. The reality is that whether you have the tools or not, you're going to ask colleagues for their input. But if you're texting, emailing, or using an other HIPAA-insecure tool, an innocent question can turn into a huge fine. If you have a HIPAA-safe telemedicine tool available to you, on the other hand, it's there when you need an answer, and you don't have to worry about staying compliant.

Ultimately, we know that you'll decide what tools you'll use based on what's best for you and what's best for your patients. But it's certainly helpful to know that a tool, and workflow that improves outcomes, together, are a route to positive things in your day and your life.

Many times, our conversations with hospital systems about iClickCare boil down to dollars and cents.

We argue that Hybrid Store-and-Forward® telemedicine, like iClickCare, is important because it reduces readmissions, reduces length of stay, improves outcomes, and decreases costs. The ROI is strongly positive.

But in reality, those metrics aren’t what pull us out of bed every morning, excited to do the work. In reality, what motivates us are the human stories behind each and every case that is facilitated by Hybrid Store-and-Forward telemedicine. It’s about individual patients thriving more, surviving life-threatening illness, and living the lives they were meant to live. But how exactly does telemedicine help with that? A pediatric neurology resident described how.

A pediatric neurology resident shared her story in the New York Times recently. She had a stroke as a baby and lost the use of her right side as a child, for the most part. When she was 4, she and her cousins were climbing trees and she realized she couldn’t reach up and grab the branches with her right hand, like the other kids could. Sad and scared, she had little idea how this limitation would evolve in her life.

As it turned out, the moment that the author realized her limitation was the moment that she decided she would learn to do as much as she possibly could. Encouraged by her parents as well, Waldron stayed after school to work on the monkey bars, played high school basketball, and was a competitive mountain bike racer. She was far from defined by her disability. And she credits her success in this way to all of the “regular life” things she did that were ultimately therapeutic for her, dramatically expanding her abilities.

As the author shares, “Sports, video games, music, friends, bedtime stories, drawing, climbing trees, going sledding, playing with dolls, building with blocks, rough housing with siblings, participating in childhood in whatever way possible, builds confidence and synapses.” Each of these moments in her life was actually part of her treatment. And the less time she spent in the hospital or doctor’s office, the most time she had for these activities that were the way in which she improved.

To me, this story shows how important it is for medical treatments to get out of the way of the patient’s life.

Especially for children with life-threatening conditions, like a stroke or cancer, it’s easy for the medical team to use an “at any cost” approach. It doesn't matter how expensive the care, how many doctors' visits it takes, or how much time we spend driving to hospitals. But for all patients, especially pediatric patients, it’s important to remember that play and school and life aren’t just “quality of life” issues — they’re actually core parts of the patient’s recovery.

That’s why when I tell colleagues that iClickCare facilitates medical collaboration such that the time patients wait for appointments, or the amount of travel they have to do, isn’t about ease or saving time. It’s about making sure that the therapeutic reality of their life is as un-curtailed as possible. Healthcare collaboration, supported by technology like Hybrid Store-and-Forward telemedicine, can have a dramatic impact on each patient getting back to regular life as quickly and efficiently as possible.

This saves the medical system money, of course— but it also means that a child might be able to climb a tree rather than sitting in a waiting room. And that can mean a dramatically better outcome.

Telemedicine is a technology with almost unlimited applications — most of which healthcare hasn’t even thought of yet.

Currently, however, telemedicine is primarily applied in pretty narrow ways. Commonly, telemedicine is used for provider-to-provider communication within the usual structure of visits. Or, it is used to allow far-flung patients to approximate a usual visit, but at a distance.

A new study turns a lot of this on its head, bringing into question our ideas about where healthcare need take place, and under what conditions.

A recent study, published in the New England Journal of Medicine, looked at the ways that it’s not just the treatment or the information that matter — it’s also where that treatment comes from, and from whom. In the study, a cluster-randomized trial, black men got blood pressure intervention in two different ways. The control group had their blood pressure measured in a barber shop, but were then referred to a physician for management. The intervention group received treatment in the barbershop itself.

More than 63 percent of the intervention group achieved a normal blood pressure level after 6 months, compared with less than 12 percent of the control group.

In fact, Carroll argues that this approach was dramatically more effective than it would have been had it been a more traditional, hospital-centered approach. He identifies a few key factors that made this intervention such a success. The care was:

From a trusted source.

Low inconvenience.

Integrated with peer support.

Dr. Carroll does point out that there are reasons that this kind of approach isn't common, however. “Health care reimbursement in the United States usually focuses on the clinical encounter, at a physician office or hospital. This reflects a belief that care is best offered there, even when evidence says otherwise. Coverage and payment focus on the individual patient, not on the community, even when research shows that the latter is more effective.”

This analysis really resonated with us as well. Telemedicine has the profound potential to support care that is from a trusted source, low inconvenience, and integrated with peer support. It has the potential to enable care that is deeply embedded into the communities, culture, and lives of the patients we serve, allowing the most advanced care, but in nontraditional settings, and with nontraditional providers as core parts of the care. Because ultimately, we don't have a failure of technology to support it -- we have a failure of imagination for what these initiatives can look like. And, as Dr. Carroll says, we have a failure of the reimbursement and payment systems.

This powerful study is proof positive, though, that we don't have to wait for the whole healthcare system to change in order for brilliant things to happen. A simple initiative, caring participants, and thoughtful, respectful design -- these are the things that enable change to happen.

Electronic Medical Records are one of the most frustrating parts of every healthcare provider's day.

EMRs are notorious for being difficult to use and to make do what you want, and they impinge on our ability to be present with patients.

I think most healthcare providers instinctively feel that the EMR is, overall, a net negative in the way they care for their patients. But a new study has some surprising results that may shock any provider who uses an EMR intensively.

The sense that Electronic Medical Records are taking a toll on medicine is one thing. But a team of researchers who published their results in JAMA recently decided to quantify that toll. The researchers looked at 1.7 million patient safety incidents reported to the Pennsylvania Patient Safety Authority and from a large multi-hospital academic medical center between 2013 and 2016. They were trying to codify whether the safety reports were linked directly to an issue of EMR usability.

The results are surprising. As Fierce Healthcare summarizes, "The authors found just 0.11% of events explicitly mentioned an EHR vendor or product and just over 500 events (0.03%) includes language explicitly referencing EHR usability."

In other words -- barely any of the incident reports related to the EMRs being hard to use.

When I read this, I furrowed my brow, not quite believing the results. The data was surprising, given my and my colleagues' felt experience with EMRs. We'd expected that many incidents would arise in one way or another from the EMRs' lack of usability.

The JAMA study defines Electronic Health Record (EHR) usability as "the extent that EHRs support clinicians in achieving their goals in a satisfying, effective, and efficient manner." Even reading that sentence puts a spotlight on current shortcomings. Few providers feel their EHR lives up to that standard.

Sure, the study design may have created far too conservative a standard for linking the patient safety issues and EHRs. (The standard was that the vendor or product be mentioned by name, which may well be unlikely even if the EHR's usability contributed to a safety incident.) But what I found even more interesting was simply my reaction to the study. I was very surprised that there weren't more related safety incidents; in fact, even the study's authors seem incredulous at the results, trying to explain why they were so low: "Broadly, patient safety incidents are notoriously underreported, and the likelihood that a clinician would include the name of the EHR vendor tightens those parameters even farther."

Our tools are so difficult to use that we think they are putting our patients in danger -- this is sobering to realize. in contrast, we made iClickCare so intuitive, so visual, and so simple that anyone understands it easily, within seconds of opening the program. And that's not because we're better funded than the entrenched EMR vendors -- it's because we care and because we have a medical and a software background.

It's time for us to demand more from the tools we use. And if your telemedicine platform or electronic health record isn't fully useable and supportive of your practice, it's time that you start demanding changes.

Last year, I was sitting at a conference room table with high-level administrators at a major hospital. They were looking for ways to use telemedicine to improve care coordination, decrease readmissions, and bring down length of stay. They were thrilled about iClickCare because, as they said, "This is something our providers would actually enjoy using."

Their main concern before moving forward with iClickCare? "It's too inexpensive."

At first we were concerned -- did they mean the solution wasn't complete enough? "No," they confirmed, "It's actually much more complete and adaptable than other solutions. It's just that our board is expecting a much more expensive purchase, with a large hardware outlay."

As counterintuitive as that experience was, the sentiment is not uncommon. So many times, we think that expensive hardware is the "right" way to approach a problem.

Similarly, recent studies are showing that time, physical activity, and over-the-counter ibuprofen is the best possible treatment for back pain. Not surgery, not an MRI, not opioids. And as healthcare providers, we know that prescribing "go for a run, take some Advil, and don't call me for a few months" may well be a harder pill for a patient to swallow than, well, a bottle of pills.

Telemedicine does not depend on expensive hardware and high-end cameras, just as most treatment for back pain doesn't depend on surgery or medication. The unglamorous truth is that telemedicine success comes from people working together effectively -- and the medical collaboration tool has to be simple and effective enough to allow that to happen.

Just as a great healthcare provider uses the least invasive treatment that will be effective, we believe the simplest telemedicine solution is usually the best one. And we know that for a lot of healthcare providers, that's a pretty big relief.

If you're ready for a simpler solution for telemedicine and healthcare collaboration, try iClickCare for free:

A working mom of four did an experiment, recently. She kept track of her time, and not just most of her time. 61% of working Americans said they did not have enough timer to do the things they wanted to do. So to understand that dynamic and see where all that time is really going, she tracked every minute of her days, in half-hour increments, for an entire year. As you can imagine, it was an illuminating exercise.

In analyzing her results, in addition to analyzing those of dozens of other people, she came to some interesting conclusions:

Most people perceive that they work much longer hours than they actually work.

Most people perceive that they are far busier - and have far less discretionary time than they actually have.

She calls it the "busy person's lies" -- those stories we tell ourselves about the choices we do and don't have when it comes to spending our time. And it made me think of the things doctors perceive about how we spend our time -- both overall and hour to hour in our medical practices. We feel constantly stressed, constantly too busy, constantly too overloaded to consider doing anything new or taking anything else on.

The point isn't that we're not doing a lot. Doctors remain the hardest working people I've ever met. It is emotionally, spiritually, physically, and intellectually taxing work. Plus, doctors have less choice than most professionals do. There is still a factory mentality in medicine that tries to squeeze every spare minute and bit of energy from doctors, such that they have very little time, energy, or bandwidth.

But just as Ms. Vanderkam's study suggests, it's possible that as doctors, just as people, we don't need more hours in the day. We need more satisfaction and contribution in the hours we have. An AMA study showed that of all the interventions for decreasing healthcare provider burnout, the two things that are actually needed to move the needle on burnout are:

Enough one-on-one time with patients.

A sense that you've done a good job.

You paid decades of training and hundreds of thousands of dollars in educational expenses to become a healthcare provider-- there is no point giving up now, when it comes to your own sense of contribution and satisfaction. So what is a doctor to do, once she has acknowledged that she wants more contribution, meaning, and control over the hours she spends at work?

It might might just be to make sure she has the tools she needs to do exactly that -- she just doesn't realize it yet.

As Dr. Khullar shares, we may be frustrated in part because we are not harnessing the right tools to really support ourselves in doing the kind of medicine we want to do. "We’re educated largely in a biomedical framework," he explains. "We diagnose disease with textbook knowledge and prescribe medications because those are the hammers we have." Khullar goes on to say that both we as providers and our patients would be better served by finding new tools, within the same minutes per visit, the same hours in a day, doing things like "leading interdisciplinary care teams; employing new technologies and methods of patient engagement like telemedicine; and appreciating how health systems fit together to influence an individual patient’s care — from home care and community centers to clinics and hospitals."

As Ms. Vanderkam quotes Natalie Henderson, a pediatric I.C.U. fellow at the University of Louisville’s Kosair Children’s Hospital: “Time goes, no matter what you do. I’m covetous of the time I have. I want to make sure I use it more wisely.”

Is contribution and overcoming healthcare provider burnout part of what you want your hours to add up to?

Learn how telemedicine can help you connect more, contribute more, and make the most of the minutes you spend with patients.

"It is only with the heart that one can see rightly; what is essential is invisible to the eye."Antoine de Saint-Exupery

As a small business trying to take on the medical system, we certainly gravitate towards things that help us be more productive. When we find a more efficient way to do something, we usually seize it.

The medical system seems to have the same impulse. If three minutes can get stripped off a visit, those three minutes get eliminated. If a step can be removed from a process, administrators are thrilled to advocate that providers do so.

Sometimes, these "efficiencies" in medicine lead to significant losses and unintended consequences.

For example, one thing we've noticed being eliminated from medicine -- because it's not efficient -- is everyday collaboration, information sharing, and human interaction. A highlight of my schedule as a surgeon has always been sitting in the doctors' lounge in the spare 10 minutes before an operation. I'd chat with other doctors who also had a free minute about new medical findings, our kids' sports, a shared patient, or a treatment conundrum. Those simple interactions would be satisfying in all kinds of ways, but with very few tangible, "efficient" outcomes. Over the course of a week, though, I always gained powerful insights, identified care opportunities, and collaborated in ways that saved time and improved quality of care.

Recently, we came across a couple of articles that show how the efficient, streamlined approach can actually strip out huge positives in other contexts. For instance:

Everything from asthma to obesity is affected by the microbial balance in our gut. As this informal article describes, some research is now showing that it is integrated, indirect consequences or combinations of healthy habits that seem to improve our intestines' microbial makeup and protect us from disease. For instance, the negative effects of a McDonald's breakfast on inflammation can be nullified by drinking a glass of orange juice with the meal. Researchers haven't yet been able to strip out the "active" component of the orange juice in the dynamic system and are concluding that it is actually the combination of things like flavinoids, antioxidants, vitamins and soluble fiber that create the effect.

It turns out that "Ground-up artemisia plants, from which the anti-malaria drug artemisinin is derived, appear to work much better than the refined drug does by itself, according to research at the University of Massachusetts," reports the New York Times. Why? The plant goes beyond just the active ingredient that we extract to create the anti-malaria drug. Much like with the orange juice (or the doctors' lounge), it is a combination of multiple factors that create the positive effects -- and a shortcut won't get you all the way there.

That's why, when we are asked for advice on telemedicine and medical collaboration, we always suggest using common sense and not necessarily doing the most efficient, stripped down, basic thing. For instance, secure text messaging services can be effective in some situations, but often lose the richness of real interactions. Sometimes, a face to face conversation is still the best way to determine a course of treatment. And when that's not possible, we believe that a telemedicine solution that incorporates informal discussion, video, photos, and perspectives from multiple providers (like iClickCare) is the way to go.

In the same way that the plants are more effective than the malaria drug itself, we advocate for "leaving in" some of the still-inexplicable positives that come from doing the traditional thing that works. Have the conversation, even if it's not 100% obvious what came of it. Use the richer store-and-forward solution. Do what works, even if we don't yet understand all the reasons why it works so well.

To learn more about why Hybrid Store and Forward Telemedicine is often the best option, get our free guide:

It can be easy to feel that things are getting worse and worse in medicine. EMRs/EHRs that seem possessed by a demon, ever-shorter visit windows, and climbing stacks of paperwork all contribute to an atmosphere of "I thought things couldn't get worse. And then they did."

But when it comes to telemedicine and medical collaboration, the trend is assuredly positive. Especially in the last few months, one obstacle to telemedicine after another is crumbling. Likely driven by incentives to cut costs while improving care, the government, insurance companies, and providers -- all of which are starting to move in the same direction and making choices to support telemedicine.

We believe medical providers need to pioneer their own telemedicine and medical collaboration practices, even without widespread support. But it certainly can't hurt if some of the obstacles are removed.

Here are our top favorites:

Smartphones and tablets make adoption effortless (or close to it).When clunky, expensive hardware was the only option, it was hard for medical providers to adopt telemedicine. Not only was it a pain to interrupt your day to go to the "videoconferencing room," these options also meant that providers had to wait for large budgets to act. “We’ve moved to a belief that you have to deliver this to a phone or tablet in order to get the adoption you want,” says Margaret Laws, the Innovations for the Underserved program director at the California Healthcare Foundation. And since using telemedicine or collaborating on a smartphone or tablet is easier than ever, there is good news for the spread of the practice.

Regulations are starting to get smarter.In one example, a new bill would remove health software and clinical software from the FDA's jurisdiction. Is it possible that common sense might just be winning out?

Reimbursements are finally coming together.As of last week, there are now 22 states that require telehealth visits to be reimbursed at the same rate as in-person visits. New York State's Governor Cuomo just signed a law that allows NY providers to bill for live video/audio, store-and-forward, and remote patient monitoring from private insurers and Medicaid. And other efforts continue to move forward, as well: a Colorado bill has just moved to the House that would prohibit health insurance plans from requiring in-person care.

New tools make workflow a snap.We've always believed that telemedicine is less about technology than it is about people and good workflow. When a telemedicine solution is easy to use and works with the schedule of the provider, then the technology can really be adopted. For instance, we've found that a Hybrid Store-and-Forward® solution removes the need for providers to play telephone tag, schedule video conferences, or wait for consults.

So let this post be one vote for the "glass being half-full" -- and getting fuller every day.

To learn more about Hybrid Store-and-Forward Telemedicine, get our free guide: